Perineal Massage

What is the perineum?
The perineum is the area between your vaginal opening and rectum. This is the area that stretches and may tear during delivery. If your health care provider cuts an episiotomy, this is the tissue that is cut. If you tear or an episiotomy is cut during delivery, this area may need stitches.

What is perineal massage?
Perineal massage is the practice of gently stretching and massaging the tissues that surround the opening of a pregnant woman’s vagina in preparation for childbirth. The intention is to attempt to prevent tearing of the perineum during birth or needing an episiotomy.

What are the benefits of perineal massage?
Several studies have shown that perineal massage when performed regularly during the last weeks of pregnancy can decrease your risks of tearing or getting an episiotomy during childbirth and may help you experience less stinging sensation as your baby’s head is delivering.

Who benefits most from perineal massage?
Perineal massage seems to work better for some women than others. Women who are having their first baby, women over 30 and women who have had an episiotomy before seem to have fewer and less severe tears when regular perineal massage is started at 34 weeks gestation.

How do you do perineal massage?
*Discuss with your health care provider before beginning.
*Begin at 34 weeks gestation.
*Wash your hands and cut your nails short.
*Relax in a comfortable and private location with your knees bent.
*Lubricate your thumbs and the perineum with natural oils (olive or almond), K-Y jelly or your body’s natural lubricant. Do not use petroleum jelly, baby oil or mineral oil.
*Place your thumbs 1.5 inches inside the vaginal opening. Press down and to the sides until you feel a slight burning. (If your partner is performing the perineal massage for you, follow the same basic instructions but he or she should use their index finger.)
*Hold this position for 1 to 2 minutes.
*Then, slowly massage the lower opening of the vagina in a U-shaped motion. Continue for an additional 8 minutes.
*Best results occur if you do perineal massage at least once every day for a total of 10 minutes.
http://www.midwife.org/siteFiles/news/sharewithwomen50_1.pdf

Are there any risks with perineal massage?
We don’t know of any risks associated with perineal massage. It is easy to do and most women don’t mind doing it. However, I have seen several women come to labor and delivery with bleeding from the perineum after massage was performed. Therefore, gentle stretching and use of a gentle lubricant are very important. Avoid the urethra (at the top of the vaginal opening) and do not massage if you have an active vaginal infection.

What are other interventions that decrease my risks of tearing during childbirth? Side-lying or upright pushing position, application of warm compresses to the perineum during labor, controlled delivery of the baby’s head, manual support of the perineum during the delivery of the head and avoidance of episiotomy have also been shown to decrease the risks of tearing during delivery.

References:

1. Perineal Massage in Pregnancy. J Midwifery Womens Health. 2005;50(1):63-4 http://www.midwife.org/siteFiles/news/sharewithwomen50_1.pdf

2. Beckman MM. antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2006(1): CD005123 http://www.cochrane.org/reviews/en/ab005123.html

3. Albers LL. Minimizing genital tract trauma and related pain following spontaneious vaginal birth. J Midwifery Women Health. 2007 May-Jun;52(3):246-53 http://www.medscape.com/viewarticle/558117_12

4. Hastings-Tolsma M, Vincent D, Emeis C, Grancisco T. Getting through birth in one piece: protecing the perineum. MCN Am J Matern Child Nurs. 2007 May-Jun;52(3):158-64 http://www.ncbi.nlm.nih.gov/pubmed/17479052?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

5. Stamp G, Kruzins G, Crowther C. Perineal massage in labour in prevention of perineal trauma: randomised controlled trial. BMJ. 2001 May 26;322(7297):1277-80 http://bmj.bmjjournals.com/cgi/content/abstract/322/7297/1277

6. Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Am J Obstet Gynecol. 2000 Jan;182(1 Pt 1):76-80. http://www.ncbi.nlm.nih.gov/pubmed/10649159?dopt=Abstract